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Fat Nation is a social history of obesity in the United States since the second World War. In confronting this familiar topic from a historical perspective, the book attempts to show that obesity is a symptom of complex changes that have transpired over the past half century to our food, our living habits, our life patterns, our built environments, and our social interactions. The book offers its readers solid grounding in the known science underlying obesity (genetic set points, complex endocrine feedback loops, neurochemical messengering) but then makes the novel argument that obesity is a result of the interaction of our genes with our environment. That is, our bodies have always been programmed to become obese, but until recently never had the opportunity to do so. Now, with cheap calories ubiquitous (particularly in the form of sucrose) , unwalkable physical spaces, deteriorating rituals and norms surrounding eating, and the withering of cooking skills, nearly every American daily confronts the challenge of not putting on weight.This is no mere cosmetic problem. Obesity is rapidly shortening the lives of Americans through accelerating rates of type II diabetes, increased rates of stroke and heart disease, and increased prevalence of joint diseases. Obesity undermines professional and social aspirations. It is highly correlated with poverty and inversely correlated with social mobility. And, it is proving intractable.Our built environment has changed drastically over the past several generations from one oriented toward walking to one oriented toward driving - in particular, driving private cars. In building unwalkable suburbs and exurbs, we have depressed American ambulation from an average of 12-14 miles per day in the 19th century, to less than one-half of one mile per day at present. We have done this by systematically making walking as inconvenient and unpleasant as we possibly can, isolating our homes from our offices, stores, schools, and churches, and surrounding most of our destinations with acres of parking lots and limited access highways. Indeed, one scholar has suggested that our suburbs are design around one primary goal: for the optimal convenience of private cars.Our families and living patterns have changed substantially since 1945, with many more woman working, many fewer American living in households with nuclear families, and most American choosing to marry and have children later in life. All of these changes have eroded traditional mealtimes, patterns of food preparation, and eating. I argue that these culinary changes have not been for the better. The breakdown in traditional meals and the decline in cooking skills has produced a nation of people who consume more than half of their meals out of the house, and consume many of the remainder from prepared and processed foods. These changes have produced diets higher in fats and carbohydrates, and lower in fibers and lean proteins, than we have traditionally eaten, all of which have led to odd alterations in our satiation response. A Big Mac is not exactly toxic, but it is designed to be eaten far too quickly for our satiation response to act. Our appetites did not evolve to handle fast food on a regular basis.We work longer hours, commute farther, move less, cook less, eat faster, and chew less than ever before in history. When hungry, we are faced with ubiquitous hyper-palatable sweets and temptations - most of which are cheap and many of which seem more and more to be addictive. At the same time, many social structures which previously dictated our mealtime rituals and mores have weakened. Not so long ago, nightly family dinners were the norm for most Americans; today, Americans are encouraged by development specialists to try to achieve this lofty accomplishment once per week.Fat Nation is also a history of the science underlying our understanding of obesity, including the active debates in the 1950s surrounding the relative importance of fats and carbohydrates in the diet in promoting obesity and diabetes, and the many recent discoveries of the complex hormonal interactions which govern hunger and satiety. We are coming to appreciate at ever more subtle levels that not all calories are the same, that we have less control over how we eat and move than we might think, and that our genes govern our waste lines more than we might hope. A major argument of the book is that very few people can realistically lose weight and maintain their weight loss. Our eating is less volitional than we tend to think, and powerful hormonal messages impel us to eat more and move less in an effort to "defend" established weight. While a few hardy people are able to resist these urges, most people are ultimately defeated. The allure of food and sloth is simply too great; the opportunities to indulge too present; the cost of indulging too low.The solution for most people must be a radically altered environment in which food is far less available and physical movement more compelling. In making this case, I spend a good deal of time establishing that much of our eating is unconscious or semi-conscious, and that we are highly susceptible to eating and exercise cues from our peers and families. Obesity is contagious, and one strategy used by the few people who successfully maintain a healthy weight is to carefully control their physical and food environments and social spheres in such a way as to remove temptation and unhealthy cues. Such efforts are costly, and it is no surprise that wealthier Americans are far more successful at staying thin than their poor compatriots. Staying thin is costly and hard. Those of us who are faced with limitations on our budgets, schedules, and energy cannot really hope to compete.I devote considerable space in the book to research on self-restraint and volition. Given that a common response to obesity is to tell people to "just
About the Author
I am a historian of science and medicine, with particular interest in the historical development of health and science policy in the United States. I work with archival materials, but try to find a narrative line to make my books interesting for my readers. I am endlessly fascinated with the ways in which people and institutions evolve (or fail to evolve!) . Please contact me through my author's page if you have thoughts or comments about any of my books.
